Provider Demographics
NPI:1215453196
Name:HALLEY, KRISTINE (PHARMD)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:HALLEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 HAWKRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-7637
Mailing Address - Country:US
Mailing Address - Phone:410-967-1863
Mailing Address - Fax:
Practice Address - Street 1:3350 WORTHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:MD
Practice Address - Zip Code:21704-7025
Practice Address - Country:US
Practice Address - Phone:240-699-0018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25202183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist